Healthcare Provider Details

I. General information

NPI: 1164610036
Provider Name (Legal Business Name): ALEXANDER MEDICAL ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8306 WILSHIRE BLVD SUITE 104
BEVERLY HILLS CA
90211-2304
US

IV. Provider business mailing address

8306 WILSHIRE BLVD SUITE 104
BEVERLY HILLS CA
90211-2304
US

V. Phone/Fax

Practice location:
  • Phone: 800-274-7036
  • Fax:
Mailing address:
  • Phone: 800-274-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA81199
License Number StateCA

VIII. Authorized Official

Name: NICOLE KATHRYNE ALEXANDER
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 80027407036